NOTE: If you're a right-wing conservative Republican you probably won't like this post. Just an FYI.
THE COST OF A TOTAL KNEE REPLACEMENT IN THE UNITED STATES:
From the hospital:
Room - Two beds or more: $3695.34
Medical/Surgical Supplies: $871.20
Medical/Surgical Supplies: $20,745.63
Lab Services: $1459.32
Lab Services: $966.40
Lab Services: $626.88
X-Ray Services: $520.77
X-Ray Services: $376.41
Operating Room: $20,755.78
Anesthesia Supplies: $4894.06
Blood Processing: $1075.70
Blood Administration: $808.89
Physio/Mech Therapy: $1013.41
Physio/Mech Therapy: $225.97
Recovery Room: $4211.30
From the surgeon:
X-Ray Service: $50.00
From the Anesthesiologist:
From the rehab hospital following my knee replacement:
Room - Two beds or more: $26,568.00
Lab Services: $1681.05
Lab Services: $364.68
Lab Services: $1134.02
Lab Services: $202.32
Physio/Mech Therapy: $5441.09
Physio/Mech Therapy: $514.29
GRAND TOTAL: $127,029.93
Okay, so we have $13,160.66 just for drugs alone. Note, these are my day-to-day prescriptions that I take every day and pay about $150/month for. The only additional meds I had was the Dilaudid for pain and several over-the-counter supplements such as iron, potassium, and vitamin C. This is truly unbelievable! I mean, I am shocked. $13,160.66 is about what I paid for my car.
I am so effin' grateful for our health insurance. But to say that our country doesn't need immediate and drastic health insurance reform is INSANE. In my opinion, all doctors should be held to the same standard of excellence and the costs of health care should be regulated. Pharmaceutical companies should not be allowed to financially devestate consumers who may have no choice between taking certain medications and serious illness or death, while our legislators reap the financial benefits of campaign contributions from the pharmaceutical companies. It's morally wrong.
And you know what? Jesus Christ would not have charged money to heal the sick. Why can we not look out for our fellow man? My husband's Canadian step-mother had the exact same surgery as I did in Saskatchewan, and her cost was $0.00.
These opinions are mine and mine alone. Your mileage may vary.
Wednesday, January 26, 2011
Tuesday, January 18, 2011
Oh, my friends, what a difficult road it’s been! I’ll give you the lowdown on my surgery -- I have had a full knee replacement. Yep, that's my brand spanking new knee in the picture above.
I should warn you that this entry is super long. Well, it's a long story, so please indulge me! Anyhow.
I should warn you that this entry is super long. Well, it's a long story, so please indulge me! Anyhow.
My surgery was on Monday the 27th. I arrived at the hospital at 5:35 a.m. and sat in a waiting room with a bunch of other people who there also waiting for surgery. There was an elderly man who was wandering around the waiting area asking (to no one in particular) where he could pick a number, as if we were at the deli counter at King Soopers. “Yes, I’ll take half a pound of the shaved gruyere, a pound of maple ham, and a full knee replacement please . . . “ Finally we were all herded into the pre-surgical suite and made to strip down nekkid and put on a very glamourous hospital gown that was ten times too big.
I was having a huge amount of anxiety by this point. The nurse came over and was very nice. She asked me to go pee in a cup because they had to ensure I was not pregnant (I am not pregnant, fwiw), so I took the cup to the bathroom to try. Well, I tried. I really did. At one point some other nurse flung the bathroom door open while I was perched on the loo, which of course made my bladder close in on itself like a frightened sea anemone. I burst into tears. My nurse came over and patted me on the back. “Don’t worry,” she said, “We can do a blood test.” And then the usual brou-ha-ha regarding me, my little hands and veins, and how deeply my veins are in my hands and arms are set.
Nurse: I’ve been doing this for 45 years – I’ve never met a vein I couldn’t eventually coax into compliance.
ME: [THINKING] First, you just had to say it out loud (it’s probably not even truthful really; I mean no one is perfect) didn’t you? Second, you have never met me – I am not overly known for being generally compliant.
Nurse: [Searching for a vein] Wow, you really do have tiny veins!
Nurse: [Searches more] Huh!
Me: I know, right?
Nurse: I think I’ve found one. [flicks top of my hand with her finger]. Okay . . .
So she shoots it up with lidocaine and inserts the IV. Thank GOD she used lidocaine because, as expected, she missed my vein, and then had to start fishing around looking around for a vein in my hand. Finally she gave up and put the IV in the crook of my arm by the elbow. Suprisingly, this did not turn out to be problematic during the entire hospital stay and I did not blow my vein.
Then I had a panic attack. I could not stop crying – I told my nurse that I was scared of the anesthesia and that I was scared of this particular surgery. Karen, the nurse, was very nice about it and patted my hand until the anesthesiologist came along. Poor man – he was probably insulted because when he introduced himself I really began to bawl! God, I was like a baby on its way to a bris. Dr. Anesthesiologist was also very nice and very patient with me and my blubbering. He then proceeded to put in a nerve block. A nerve block is a small tube that is strategically placed down the leg where large doses of pain medication is injected into whatever particular part of the body that is being operated on. So getting the nerve block put in was very uncomfortable because I could feel the tube being inserted. I was really upset, so the doctor said to the nurse, “Let’s give her five ccs of Ativan.” To which I said, “Like on House MD.”
The next thing I remember is . . . WAKING UP after the surgery and it was all done! The recovery nurses don’t mess around. They were shaking my head and calling my name: “Julie . . . Julie . . .you have to wake up now. Show us that you’re awake.” Seeing as I was NOT awake, I drooled and made honking noises or somesuch to prove that I was at least alive, if not awake. As well, to prevent nausea, Dr. Anesthesiologist had given me Phenergan and Zofran, and Phenergan is like a horse tranquilizer to me. It makes me exceedingly groggy; I ended up sleeping until 4:00 p.m., while occasionally moaning and bewailing my lot in life to yet again demonstrate my presence among the living.
At this point my pain was okay, as the nerve block had not yet worn off. They clipped the PCA pump to my gown and curled my fingers around the button and made me push it several times to show that I knew how to use it. The PCA pump has never been an effective form of pain management for me. Because it uses morphine most often, the PCA pump tends to put me to sleep almost immediately. So I would push the button a few times, and then would nod off. Meanwhile, because I wasn’t treating my pain regularly, it would spiral into waves of massive pain that took a long time to bring back under control. It’s always easier to keep pain under control if you use continuous pain medication than if you let the pain get really bad and then try and bring the pain down from an acute state. I think all doctors need to plan for their patients to have breakthrough pain, too, because nothing sucks more than having breakthrough pain and being told you can’t have any more pain control for four more hours. So, anyhow, I had a lot of pain the first day and night.
By the end of the second day I was, like, crying and openly demanding more pain meds. At this point I was ENRAGED at having to suffer. I had specifically informed all my doctors prior to the surgery and the nurses afterward that I had been on pain management for two years, and that subsequently my tolerance to pain meds was going to be higher than the average patient’s. It’s like no one listened to me on this very important issue. I mean, it was essentially like recovering from surgery ala Civil War style – Here, woman, bite down on this belt strap while I saw your leg off . . . may I offer you some whiskey? *banjos duel* Except no one even offered whiskey!
Finally, this wonderful nurse, Tammy, took the time to ask who my pain management doctor was and what his contact info was. PRAISE ALLAH, JESUS, BUDDHA, EVERYTHING AND EVERYONE!!!! She tracked down my pain management doctor and talked with him about my situation and that’s when my pain meds were finally adjusted to add IV Dilaudid every two hours to control breakthrough pain. I would also stick to my usual regime of morphine and oxycodone three times per day. That finally brought my pain down to a 4-5, which is fantastic compared to being at a 10. A 10 means I’m literally writhing and crying and calling for my mommy and rocking back and forth, etc. I used to say that on a scale of 1 to 10, with one being the least amount of pain and ten being the most painful pain ever, that my kaput gallbladder was like a 15, it was just that painful.
I know now that I was wrong. A knee replacement is like a 20 on a 1-10 scale and is easily the most painful procedure I’ve ever had done (including childbirth)
On the day after I had the surgery, the physical therapy team came to get me out of bed. They were brutal, man. They pried me out of my Big Bird nest kicking (with my good leg) and screaming about how I didn’t want to stand up and that surely my leg would now fall off. I actually wasn't able to specifically verbalize this beyond snarling and making the Chewbacca noise. They finally got me into a walker where I managed to take one step. One. Step. I couldn’t go any further. The pain was just too great. The physical therapy team felt that I had accomplished a lot by taking a step; I thought I had too, considering what the actual knee replacement procedure entails.
I won’t detail every day of trying, and failing, to walk, but what happened was that I was deemed unsafe to go home because of the lack of handrails on the outside stairs, plus the bedroom and only full bath being up a flight of 20 hardwood, narrow stairs. Also, I couldn’t get out of bed alone, or get dressed, or go to the bathroom, prepare a meal, or answer the front door. I couldn’t do anything for myself and they were also concerned about the tremendous amount of pain I was still experiencing. It was apparently excessive and beyond the scope of the average patient. So that’s when the decision was made for me to be transferred to Spalding Rehabilitation Hospital out in Aurora.
Spalding almost didn’t accept me because they don’t normally take such short-term rehabilitations cases. They deal with individuals who are recovering from stroke, TBI, serious accidents, etc. They accepted me because I had had cervical (spine) surgery only two weeks prior and that made them feel that I was an appropriate candidate for their program. Otherwise I would have had to have gone to a nursing home to convalesce and OMG just no. So I was grateful I was able to get into Spalding.
Upon release from the hospital, it took nearly fifteen minutes to figure out how to get me into the car without bumping my left leg or getting it turned the wrong way and inducing waves of stabbing, shooting pain. Finally, DH, the kids, and the CNA managed to get me into the car. We drove from the hospital to Spalding in about 20 minutes (it would have been less time but we got lost), and then it took an additional ten minutes to get me out of the car. We were met by an aide who wheeled me up to my room. It was spacious and very clean. The whole hospital was super clean, which was a big plus for me. Anyone who’s ever had to experience the smell of a nursing home will never forget it. The daily schedule was very regimented, which was a good thing. It means everyone got the physical and occupational therapy that they needed. For example, here is my schedule for a typical day:
7:00 a.m. Occupational Therapy
9:00 a.m. Physical Therapy
9:30 a.m. Physical Therapy
10:30 a.m. Occupational Therapy
4:00 p.m. Physical Therapy
4:30 p.m. Physical Therapy
Breakfast was from 8:00 to 9:30. Lunch was from noon to 1:30. Dinner was from 5:30 to 7:00. I had Cream of Wheat for breakfast every morning – I had forgotten how much I love Cream of Wheat with sugar and milk! Mmm, yummy goodness! My appetite was actually extremely poor following the surgery. It was no surprise, I guess. Things were disrupted; I was away from my husband and children; I missed my house; I missed my pets; etc. I’ll take advantage of a poor appetite for as long as possible, though. It's been about three weeks since the surgery and I've lost about 10 pounds I'm guestimating (the battery in our scale has died).
Anyhow, the nurses were all very, very kind. They were happy to get you a glass of ice, help you to the bathroom, bring crackers, and bring pain meds without encouraging you to “tough it out just a little longer” when you’re already hurting at a level 9. When I first arrived at Spalding, I was greeted by the PAC of the facility, Miguel, who couldn’t have been nicer. He was the first medical professional to tell me that their facility was not there to question my pain or the legitimacy of my pain. They were there to ensure that their patients’ pain is managed and that no one goes on being in pain when they don’t have to. He spent about 20 minutes talking with me about my pain management – what meds did I take? What were my dosages? What was my pain management like in the hospital? Exactly how did I take my pain meds – in what combo, at what times, in what order? What worked? What didn’t work? How long had I been on these medications? Etc. They did a full medical history – both the PAC and the nurse on duty, which I felt was professional and thorough.
I can’t tell you much I have come to empathize with individuals who have permanent physical disabilities. Upon my arrival at Spalding, I could not shower, change my clothes, get in or out of bed, or get onto the toilet without physical assistance. I could not, and still cannot, lift anything heavier than five pounds. Showering and getting dressed takes about an hour; I have to shower using a special chair that comes partially out of the tub that I sit on to get undressed. Then, I have to manage to lift my leg fifteen inches over the tub wall and into the tub and then maneuver my body and other leg into the tub WITHOUT getting water everywhere! DH installed a shower wand and a shower chair. I have a looped gadget to lift my leg off the floor and put it onto the bed or couch, a grabber claw that picks things up, a ginormous shoe horn, a sock put-er-onner thing that is extremely cool, and a pair of crutches.
The only negative thing that happened while I was at Spalding was that for one night I had a terrible nurse. I called for pain meds at 1:00 a.m. She came into my room, apparently in a foul mood or something, and when I requested medication she snarked that I take too much pain medication and that she was not willing to give me more, even though my meds order called for oxycodone every four hours and morphine three times per day. I had had a really painful day due to physical therapy and other factors that are so random and nebulous that I can't really explain them well. Some days the pain is just worse than other days; that night it just happened to be pretty bad. Anyhow, this nurse said to me, “Pills! All you want are more pills, pills, pills.” I objected to this and reiterated that I was asking for pain meds as per my schedule and that I was hurting, which was why I was asking for pain meds to begin with. She left my room without giving me my pain meds, which left me in a lot of pain for an additional three hours, when she was finally willing to give me my medication.
I am planning on lodging a formal complaint. It is completely inappropriate to withhold medication from a patient, and it was inappropriate for her to make judgments of my character by implying I was narcotics-seeking and that all I want to do is get more pain meds as if to get high. I was not asking for medication outside the parameters of my prescription. I have never tried to get my pain management doctor to give me meds that I don’t need. (Now screaming for more meds immediately following surgery is different – that was acute and I had an immediate need for significant pain relief). I won’t go on and on about the thousand other ways in which this nurse was irritating and inappropriate, but suffice it to say it is my opinion that she should not be in nursing, a helping profession. Also . . . she kind of looked like a Hobbit. Really, really weird, with the most odd, stubby fingers I’ve ever seen on a person. Not that that had anything to do with her being unprofessional, but it was jarring all the same. Talk about Nurse Ratchett!
I was able to eat either in the dining room or in my room. I almost always ate in my room. I liked the down time and the opportunity to have some time to myself. The food was awful the first day, but subsequently improved. I liked that they used fresh vegetables instead of canned. They had me on a protein supplement; apparently my protein levels are low. I’m also really anemic again. I ended up having to have two transfusions in the hospital to boost my iron levels. This time the levels got down to 23 (normal for a woman my age is 37.5) and 6 (normal is 8-12). The attending physician said he had not seen some sort of level – iron protein? Something like that – as low as mine. I need to call my hematologist and make an appointment. Maybe IV iron treatments would be appropriate again. I’m back on iron supplements.
Truthfully, I have not been overly careful with my diet for some time now. And I’m sure the anemia is due to this. It’s definitely iron-deficiency anemia, rather than pernicious anemia, which is anemia due to a lack of vitamin B12. Now that I don’t have as many stressors in my life, I think it’s time for me to give my attention to my health. That means keeping a food diary. I have an account at MyFoodDiary.com; maybe there’s a way to set it to monitor iron intake specifically. And, of course, there’s the gym.
The gym. *sigh*
I watched more television at Spalding than I had in, well, quite a long time. I liked TNT the best for mindless background TV, with shows that I generally like: Law and Order; Cold Case; The Closer; Angel; Bones. It also carries what could possibly be the worst show ever produced for television: Charmed. Holy cow, what a jackwagon of a show Charmed is! I love how the girls just do *jazz hands* and this ridiculous burst of bad CGI lightning bursts from their fingertips, and that is how they demonstrate their magic. It’s just so awful, LOL! The storylines are like bad!Buffy to the nth degree. It’s so bad it’s amusing. It’s tying The Secret Life of the American Teenager for worst TV show ever.
Anyhow, I made a lot of progress at Spalding. I went from being completely unable to walk to being able to walk rather well with a walker and an immobilizer. My need for pain medications went down, which was wonderful, considering the whole point of this surgery is to be able to regain my mobility and get off the pain meds, right?I stayed at Spalding for ten days -- I really needed the rehab and am glad I was afforded the opportunity to stay there and receive such intense therapy. Three weeks out and I can walk without assistance! I am able to go without the immobilizer more and more frequently. Sleep is becoming comfortable again, as I am able to roll onto my side now. I have a really funny in-home physical therapist who I enjoyed working with for the first time yesterday. He fixed my CPM machine for me (a CPM is a Continuous Passive Motion machine, which gently moves your leg and knee to loosen it up and prevent scar tissue. All you have to do is strap your leg into it and turn it on and away it goes!), but Murphy's Law would prescribe that the morning after the machine was finally fixed, the home health care agency would arrive to take the machine back because insurance would only pay for a three week rental. Alas!
I do have, though, this awesome continuous cooling machine which I get to keep. Essentially, it's a small cooler of ice and water connected to a set of pads that wrap around the knee. It pumps the ice cold water through the pads continuously for up to, like, five or six hours. It's fantastic! Nothing feels better on a sore knee than a good ice pack, especially after physical therapy or walking for extended periods of time.
So, you may be asking yourself, when will FATG attempt to actually step inside her 24 Hour Fiitness? Well, FATG has a physical therapy session set for Thursday and she will ask her physical therapist, Tom, when she can safely go to the gym and begin working on the treadmill. Depending what he thinks, FATG will attempt to enter the gym ASAP. It's a new year, my friends. Time to leave the fear behind, yes?